Letter: Replying to the Letter Entitled “Mean Platelet Volume/Platelet Count Ratio and Dipper/Non-Dipper Hypertensive Patients”

We thank Dr. Kızıltunç et al. for their comments regarding our study, which demonstrated a relationship between the Mean Platelet Volume/Platelet Count Ratio and dipper/non-dipper hypertensive patients.^1,2

In their initial observations, Kızıltunç et al. emphasized the importance of fully accepting the circadian pattern types of blood pressure (BP). ² We agree with this statement. However, due to the limited number of patients exhibiting extreme dipper and reverse dipper hypertension patterns in our study, these cases were excluded from the analysis.

In their second comment, Kızıltunç et al. suggested that the assertion regarding the Mean Platelet Volume/Platelet Count (MPV/PC) ratios potentially indicating cardiovascular (CV) risk in non-dipper hypertension compared with dipper hypertension is a bold claim given the current study design. ² Previous studies have established that systemic immune-inflammation indices based on platelet, neutrophil, and lymphocyte counts [SII (systemic immune-inflammation index) = NLR (neutrophil/lymphocyte) × platelet count or PLR (platelet/lymphocyte) × neutrophil count] serve as strong prognostic markers in cardiovascular diseases.^{3 –5} Increased platelet activation plays a significant role in the development of atherosclerosis. ⁶ Larger platelets, which contain denser granules, are metabolically and enzymatically more active than smaller platelets and possess a higher thrombotic potential. ⁷ MPV, a marker of platelet activation, has been recognized as an independent risk factor for hypertension, myocardial infarction, and stroke.^8,9 Azab et al. indicated that the increased MPV/PC ratio better predicts long-term cardiovascular mortality in patients with acute coronary syndrome without ST elevation, compared with MPV and PC alone. ¹⁰ The role of inflammation in the pathogenesis of hypertension is well established. ¹¹ Inflammation contributes to the development of hypertension and target organ damage. ¹² Consequently, our hypothesis that “the MPV/PC ratio may indicate CV risk in non-dipper hypertension compared with dipper hypertension” ¹ is consistent with previous findings. However, more extensive and prospective studies are needed to obtain more definitive results.